OPHTE# G7-00-1$kS4 Harnett County Department of Public Health 19683
PERMIT # _q16~-_ Operation Permit
1 New Installation -1 Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) SUBDIVISION _AA St LOT # l(~_
System Installer. Registration #
Basement with plumbing: ❑ Garage 541 Number of Bedrooms
Type of Water Supp . CoQmmun`ity >I Public ❑ Well D' ance from well ~J feet
System Type: ~,vr F c ( IS ~i, Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
> gitma nm vacn ursrama in complance wim appnaM north Urolma General Statutes, RtAes for Sewage Treatment and Disposal, and as col-tiom of the Improvemmt Permit and Construction Audtorineon
~11 --1 1
PFANIT rnNnrrInYt-
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I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring. As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional ooeratio
IV. Operation:
V. Other
maintenance and reporting.
Following are the specifications for the seewge disposal- on the above captioned property.
Type of system: ❑ Conventional Other Size of tank: Septic Tank J D gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch- feet ditches feet ditches L { inches
French Drain Required: Linear feet
Lhthoriz~ed State Agent \ \ ~ ~ Date --5 -,1 - 0 q I